Transcript INNF Presentation - Arif Mahmood

Evidence-based advice to inform
commissioning decisions on
“Interventions Not Normally Funded”
Dr Arif Mahmood
Specialist Registrar in Public Health
National Public Health service for Wales
Dr Mary Webb
Health Service Quality and Development Team
National Public Health service for Wales
Policy Context
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The Welsh Health Circular (2003) 63 - LHBs and Health
Commission Wales are the statutory commissioning bodies
in Wales
And the NPHS has a responsibility to provide public health
resources and expertise to enable them to carry out their
statutory duties
“Designed for Life” and “Fulfilled Lives and Supportive
Communities” - identified commissioning as a vital tool to
reform health and social services
The WHC (2007) 023 – identified commissioning as a
process to specify, secure and monitor services that are
evidence-based, cost effective, of high quality and meet
individual needs
NHS Core Values
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Fairness
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Effectiveness
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Efficiency
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Responsiveness
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Integration
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Accountability
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Flexibility
Guiding principles for commissioners
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Legality (is it lawful?)
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Safety ('first do no harm')
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Clinical Effectiveness (does it work?)
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Cost Effectiveness (is it an efficient way of using
resources?)
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Equity (is it a fair way of using resources?)
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Accessibility (can people get to the service?)
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Affordability (do we have the resources to pay for it?)
Purpose of the INNF advice
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The document is intended to
promote:
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Evidence based commissioning
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Efficient use of finite resources
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Equality across Wales
What is “INNF”?
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Any intervention (medical, surgical or
drug based treatment) which fulfils one or
more of the following criteria:
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There is currently insufficient evidence of
clinical effectiveness
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There is currently insufficient evidence of cost
effectiveness
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The intervention is considered to be of
relatively low priority for NHS resources locally
What is exceptionality?
In order for funding to be agreed there
must be some unusual or unique clinical
factor about the patient that suggests
that they are
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Significantly different to the general
population of patients with the condition in
question
Likely to gain significantly more benefit from
the intervention than might be expected from
the average patient with the condition
Why we did it? (1)
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In 2003, most LHBs adopted the
commissioning policies of the old health
authorities
The NPHS frequently gets requests from
LHBs for evidence-based advice on
Interventions Not Normally Funded (INNF)
In December 2006, Gwent LHBs decided to
develop a joint commissioning policy and
requested advice on INNF
Why we did it? (2)
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Client’s (Gwent LHBs) needs
Health Service Quality and Development Team
capacity
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Would other LHBs be interested?
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The NPHS decided to roll out its advice across Wales
How we did it?
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An INNF list was compiled after consulting with LHBs
across Wales
INNF Policies of a number English PCTs were also
scrutinised
Evidence of clinical/cost effectiveness for each
intervention was searched for
Market research – what sells?
Features of NPHS advice on INNF
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50 interventions
OPCS Codes
References
Hierarchy of evidence – Grading of
recommendation
Quality Assurance
Advice review
Caveats
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The primary responsibility for commissioning
remains with the LHBs and HCW, and the NPHS
has only an advisory role
Must not be interpreted as “Blanket Advice”,
Commissioners should deal with each request on
its merit considering the individual circumstances
of the patients and also adhering to the specified
guidance
The commissioners will continue to be legally
responsible for their decisions and consequences
Consultation
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This documented has been
consulted on with:
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Local Public Health Directors
LHB Medical Directors
LHB Nursing Directors
LHB CEOs - South East Region
LHB CEOs - Mid & West Region
Next steps
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Consultation with Health Commission Wales – 30th
November 2007
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Consultation with the National Specialist Advisory
Groups – 30th November 2007
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Final approval by the Health and Social Care
Strategic Management Group of the NPHS – 18th
December 2007
Publication on the NPHS website – 31st December
2007
Format of the document
Orthodontic treatments for essentially cosmetic nature
(Code: F14.-, F15.-)
Background:
Orthodontic dentistry specialises in aligning crooked teeth. The treatment
involves wearing braces. Quite often this treatment is undertaken for cosmetic reasons.
Advice: Commissioners may only fund orthodontic treatments for
essentially cosmetic nature in accordance with the guidance specified
below (Evidence grade D).
Guidance
Orthodontic treatment is usually not offered to people with a score of less than 4 or 5 on the Index of
Orthodontic Treatment Need (IOTN).
References
1.Brook P H and Shaw WC (1989). The Development of an Index of Orthodontic Treatment Priority.
European Journal of Orthodontics II: 309-320.
2.Richmond S; Shaw W C; Stephens C D et al. Orthodontics in the General Dental Service of
England and Wales: Critical assessment of standards. British Dental Journal 1993; 174: 315.
Acknowledgements
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Dr Nigel Monaghan
Dr Chris Potter
Mr Andrew Jones
Ms Sandra Caple
Mr John Frankish (NPT LHB)
Ms Jennie Willmott (Monmouth LHB)
Ms Angela Jones (Monmouth LHB)
Ms Isabel Puscus
LPHDs
LHB Medical Directors Group
LHB CEOs – SE Wales
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Dr Sarah Aitken
Dr Jenny Harries
Dr Michael Thomas
Dr Nina Williams
Ms Jo Charles
Dr Ash Paul (HCW)
Dr Richard Quirke
Ms Ruth Treharne (SE RCU)
LHB Nursing Directors
Group
LHB CEOs – Mid & West
Wales